Massachusetts Health Reform: More Than Expanding Access
Richard T. Moore (D-Uxbridge), Senate Chairman of the Legislature’s Joint Committee on Health Care and the Special Senate Committee on National Health Reform, argues that expanded access to health insurance is also leading to cost savings and improved quality of care:
As some pundits and so-called experts compare features of the landmark Massachusetts Health Care Reforms (Chapter 58 of 2006 and Chapter 305 of 2008), they assert that Massachusetts only addressed access and not quality improvement or cost control.
They concede that Massachusetts did succeed at expanding access to health insurance based on the current estimates that some 97.5% of Bay State residents are now insured, which is a higher percentage than any other "health reform state" has been able to achieve! However, claiming that Massachusetts only achieved expansion of access misses two important features of our success. Furthermore, claims that health reform is unaffordable for Massachusetts have been soundly disproven by the Massachusetts Taxpayers Foundation.
First, expanding access does, in fact, improve quality and ease cost shifting. People with health insurance are generally healthier and are less likely to have to rely on expensive emergency department care because they are able to get lower cost routine preventive care and better management of their chronic conditions. A study by Harvard Medical School for the Centers for Medicare examined Medicare claims between 1996 and 2005 and found that individuals who were uninsured before becoming eligible for Medicare at 65 had significantly higher spending than did those with coverage prior to Medicare enrollment. The uninsured have postponed needed care, making them generally sicker and therefore, more expensive for taxpayers. Access to health care saves lives and money! It improves quality of life and helps contain costs.
There is much more to Massachusetts Health Reform than expanding access, however. Both Health Reform I [Chapter 58] and Health Reform II [Chapter 305] established a strong foundation for improving health care quality and reducing health care costs - in short, making health care accountable.
Recently, the Boston Globe reported significant improvements in reducing hospital acquired infection rates. According to this report, Massachusetts' largest hospitals say they have significantly cut the number of patients who acquire painful, costly, and sometimes deadly infections in their operating suites and intensive care units (ICU's), suggesting that pressure from government regulators and patient groups, as well as a shift in doctors’ attitudes, is starting to make medical care safer. This fifty percent reduction in intravenous line infections and reduction of pneumonia from patients on ventilators has reduced current costs and even contributed to cancelling capital expansion of the ICU at Beth Israel Deaconess Hospital.
This is exactly the sort of improvement in quality and cost reduction envisioned by legislators when provisions - and funding - for a statewide infection prevention program and links to the CDC infection reporting system were included in the Massachusetts health reform law in 2006 and the Quality and Cost law of 2008.
Other provisions of the two Massachusetts Health Reform laws, include the establishment of the Quality and Cost Council and the Health Care Disparities Council, funding for the Betsy Lehman Center for Patient Safety, reorganization of the Massachusetts Public Health Council, establishment and funding of the eHealth Institute and eHealth Fund, as well as funding of the Nursing and Allied Health Trust Fund. In addition, the two laws provided for the establishment and funding of the Primary Care Workforce fund and development of goals for electronic health records.
E-health has become a rapidly expanding area of health reform, and Massachusetts has been established as a leading example in implementing health information technology. Through the Massachusetts Technology Collaborative, a statewide health information network and the development of standards for physician competency in meaningful use of health information technology are both beginning to make a genuine difference in reforming our health care delivery system.
Perhaps most significant, Health Reform II provided for a one-third reduction in the expensive storage of health records, simplifying the convoluted and excessively burdensome bill coding system. Instead, what has been created is soon-to-be unveiled transparency in the setting of health care provider charges and insurance premiums. Providers and insurers will finally be held accountable of increasing costs!
While it would be wrong to downplay the significant achievement of expanded access, enrolling people in health insurance is far easier, and can be achieved more quickly, than changing the entire culture of health care to improve quality of care and ensure that it is delivered more efficiently.
The process developed by Massachusetts is a comprehensive, step by step approach to long term improvement and consumer-friendly reform. It is an approach that is continuing to be developed and implemented as the legislature and administration begin a very complex effort to reform the health care payment system so that it provides the right incentives for improving primary care and coordinating the care of all patients, but especially those with expensive, chronic conditions.
The foundation for quality improvement and cost reduction embedded in Health Reform I and II, and the changes being developed in Health Reform III, will take at least the next five years before we experience maximum benefits. However, Massachusetts is on a bold, innovative path to more competent, compassionate care for all of its citizens. We have proven that health reform can be achieved at the state level, and we hope it inspires other states—and even our federal government—to demonstrate the courage and commitment to deliver on the opportunity for, and promise of, good health for every American.
This program aired on December 2, 2009. The audio for this program is not available.